Defining the position of deep inguinal ring in patients with indirect inguinal hernias. 2006

P Sanjay, and T D Reid, and D J Bowrey, and A Woodward
Royal Glamorgan Hospital, Llantrisant, CF72 8XR, S Wales, UK.

A preliminary survey of surgeons of all grades in our hospital revealed confusion about the position of the deep inguinal ring. Standard teaching is that the deep inguinal ring is lateral to the femoral artery. The aim of this study was to define the position of the deep ring in patients undergoing elective inguinal hernia repair. Thirty consecutive male patients undergoing indirect inguinal hernia repair under local anaesthesia were studied. The following landmarks were marked on the patient with a felt pen: anterior superior iliac spine (ASIS), femoral artery (FA), deep inguinal ring (DR), pubic tubercle (PT) and pubic symphysis (PS). The distance of each point from the ASIS was measured in centimetres. The relation of the femoral artery to the deep inguinal ring was confirmed by palpation through the deep ring during surgery. The femoral artery was consistently identified midway between the anterior superior iliac spine and pubic symphysis (mid-inguinal point). The deep inguinal ring was located medial (22/30) or above (8/30) the femoral artery, but never lateral. The mean distances from the anterior superior iliac spine to the deep ring and femoral artery were 8.8 and 7.7 cm, respectively. Contrary to standard teaching, this study demonstrates that the deep inguinal ring lies medial, not lateral, to the femoral artery. This may clarify some of the variations in textbook anatomy, and explain the difficulty in distinguishing direct and indirect inguinal hernias pre-operatively.

UI MeSH Term Description Entries
D007264 Inguinal Canal The tunnel in the lower anterior ABDOMINAL WALL through which the SPERMATIC CORD, in the male; ROUND LIGAMENT, in the female; nerves; and vessels pass. Its internal end is at the deep inguinal ring and its external end is at the superficial inguinal ring. Inguinal Ring,Canal, Inguinal,Canals, Inguinal,Inguinal Canals,Inguinal Rings,Ring, Inguinal,Rings, Inguinal
D008297 Male Males
D008488 Medical Illustration The field which deals with illustrative clarification of biomedical concepts, as in the use of diagrams and drawings. The illustration may be produced by hand, photography, computer, or other electronic or mechanical methods. Illustration, Medical,Illustrations, Medical,Medical Illustrations
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011631 Pubic Symphysis A slightly movable cartilaginous joint which occurs between the pubic bones. Pubic Symphyses,Symphyses, Pubic,Symphysis, Pubic
D001837 Body Weights and Measures Measurements of the height, weight, length, area, etc., of the human and animal body or its parts. Body Measures,Body Measure,Measure, Body,Measures, Body
D005263 Femoral Artery The main artery of the thigh, a continuation of the external iliac artery. Common Femoral Artery,Arteries, Common Femoral,Arteries, Femoral,Artery, Common Femoral,Artery, Femoral,Common Femoral Arteries,Femoral Arteries,Femoral Arteries, Common,Femoral Artery, Common
D006552 Hernia, Inguinal An abdominal hernia with an external bulge in the GROIN region. It can be classified by the location of herniation. Indirect inguinal hernias occur through the internal inguinal ring. Direct inguinal hernias occur through defects in the ABDOMINAL WALL (transversalis fascia) in Hesselbach's triangle. The former type is commonly seen in children and young adults; the latter in adults. Inguinal Hernia,Inguinal Hernia, Direct,Inguinal Hernia, Indirect,Direct Inguinal Hernia,Direct Inguinal Hernias,Hernia, Direct Inguinal,Hernia, Indirect Inguinal,Hernias, Direct Inguinal,Hernias, Indirect Inguinal,Hernias, Inguinal,Indirect Inguinal Hernia,Indirect Inguinal Hernias,Inguinal Hernias,Inguinal Hernias, Direct,Inguinal Hernias, Indirect
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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